BALTIMORE--CMS released a draft local coverage determination last week that would revise the current nebulizer coverage policy. According to the DME Program Safeguard Contractors, the proposed changes include:

--Payment for levalbuterol will be based on the allowance for albuterol;
--Payment for DuoNeb will be based on the allowance for separate unit dose vials of albuterol and ipratropium;
--Coverage for the following nebulizer drugs is eliminated because there is inadequate support in the medical literature for administration using a DME nebulizer: amikacin, atropine, beclomethasone, betamethasone, bitolerol, dexamethasone, flunisolide, formoterol, gentamicin, glycopyrrolate, terbutaline and triamcinalone. Coverage will therefore be limited to these drugs: acetylcysteine, albuterol, budesonide, cromolyn, dornase alpha, iloprost, ipratropium, isoetharine, isoproterenol, levalbuterol, metaproterenol, pentamidine, and tobramycin;
--Maximum milligrams/month for budesonide are defined.

The deadline to submit comments on the LCD is May 8.

A March 24 bulletin from DMERC A/B advises: "If you disagree with any aspect of these four changes, you should be very specific and, if possible, offer an alternative indication, guideline, etc. You should provide a clinical rationale for your position including references from the published clinical literature (e.g. standard textbooks, peer-reviewed journals, etc.). We would also encourage a written response if you agree with these changes in the policy."

Comments should be submitted to each DME PSC medical director by snail mail or via e-mail through each DME PSC's Web site. In addition, suppliers are invited to attend an upcoming meeting, which will be held by each of the three PSCs, to receive comments on the draft policy.

To contact your PSC, visit:
--Region A/B, Tricenturion, www.tricenturion.com;
--Region C, TrustSolutions, LLC, www.trustsolutionsllc.com; or
--Region D, EDS, www.edssafeguardservices.eds-gov.com.

To view a copy of the draft LCD, click here.

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